Fate of ‘uninsurables’ hinges on Supreme Court ruling

WASHINGTON (AP) — Cancer patient Kathy Watson voted Republican in 2008 and believes the government has no right telling Americans to get health insurance. Nonetheless, she says she'd be dead if it weren't for President Barack Obama's health care law.

Now the Florida small businesswoman is worried the Supreme Court will strike down her lifeline. Under the law, Watson and nearly 62,000 other “uninsurable” patients are getting coverage through a little-known program for people who have been turned away by insurance companies because of pre-existing medical conditions.

“Without it, I would have been dead on March 2,” Watson said of the Pre-Existing Condition Insurance Plan, known as PCIP. That's when she was hospitalized for a life-threatening respiratory infection.

It's not clear how the Supreme Court will rule on Obama's law, but Watson's case illustrates the potential impact of tying everything in the far-reaching legislation to the fate of one provision, the unprecedented requirement that most Americans carry health insurance.

The law's opponents say if that insurance mandate is found to be unconstitutional, the rest of the law should also go, since courts should not be picking and choosing policy. The administration defends the insurance requirement but says if the court decides to overturn it, most of the rest of the law should stay.

State officials who administer the federal pre-existing condition plan in 27 states are trying to make fallback arrangements in case the law is invalidated and coverage suddenly terminates.

Federal officials who administer the plan in the remaining 23 states and Washington, D.C., remain mum on what might happen there if the law is overturned.

The White House line is that Obama is confident the Supreme Court will uphold the Affordable Care Act, and his administration therefore is making no contingency plans for a reversal. None of that sounds reassuring to Watson.

“It's scary,” she said. “They need to look at this carefully because it is going to affect a lot of people with a lot of bad conditions who are not going to have any health care coverage.”

If the federal law is struck down, some state officials are considering taking the patients into their own, separate, state high-risk insurance pools. Wisconsin, for example, has decided that PCIP enrollees would be automatically accepted into its pool. But not all states have them. In the 35 that do, premiums would generally be higher, and there might be waiting periods.

Republicans, including presidential candidate Mitt Romney, have long favored insurance pools for high-risk patients. And Congress could take emergency action to keep PCIP going. But no assurances have been offered. Michael Steel, a spokesman for House Speaker John Boehner, says Republicans are ready to work on “step-by-step, commonsense” approaches.

Watson says she still

disagrees with Obama's requirement that individuals have health insurance, either through an employer, a government program or by purchasing their own plan. “I approve of some of it,” she said of the law, “I don't approve of the mandatory … insurance.”

But she doesn't want to go back to depending on the emergency room.

“I have no problem paying my insurance and paying my copays,” she said. “I just think I should have the right to purchase insurance.”